Therapies to Improve Vein Graft Patency After CABG - American College of Cardiology (2023)

Quick Takes

  • Vein graft occlusion occurs frequently and is related to adverse outcomes after coronary artery bypass grafting (CABG).
  • Technical factors during CABG are determinative for early graft patency.
  • To prevent vein graft occlusion, lifestyle management, antithrombotic therapies, and lipid-lowering therapies are key.

CABG is the most commonly performed cardiac surgical procedure worldwide and is preferred over percutaneous coronary intervention in patients with diabetes, reduced left ventricular ejection fraction, and three vessel and complex coronary artery disease.1 Both arterial and saphenous vein grafts (SVG) can be used as conduits. Grafting the left anterior descending artery with the left internal thoracic artery is the gold standard in CABG because patency rates of this construction surpass SVG,2 decrease the incidence of coronary reoperation, and improve survival.3,4 Use of multiple arterial grafts, compared to only a single arterial graft, potentially provides long-term survival benefit in selected patients, but this remains a topic for discussion. As such, SVG remains the most used second conduit. An important and recalcitrant issue with the use of SVG remains vein graft failure. SVG failure rates range from 6% to 26% in the first year and are estimated to be 40-50% at 10 years after CABG.5,6 Although SVG failure is not one-on-one related with adverse events, it is associated with anginal complaints, myocardial infarction, and long-term mortality after CABG.7-9 This article discusses therapies to improve vein graft patency after CABG.

(Video) Inside JACC | Radial Artery and Saphenous Vein Patency More than 5 Yrs After CABG

SVG failure is a complex, multifactorial process. In the first month after CABG, mechanical factors and endothelial damage after surgery cause thrombotic occlusion.10 Thereafter, until 1 year after CABG, the predominant process causing failure is intimal hyperplasia. Activated platelets trigger inflammation, causing smooth muscle cell migration from the media to the intima.11 Both thrombosis and intimal hyperplasia provide the foundation for accelerated atherosclerosis, which is the principal cause of failure beyond the first year after CABG.12

Technical Improvements
Technical improvements in SVG construction during CABG should be taken into account to improve vein graft patency. Regarding SVG harvest and preservation, early studies showed reduced patency rates for endoscopic vein harvesting compared with the conventional open harvest technique,13 although a recent clinical trial that included 1,150 patients demonstrated no difference in major adverse cardiac events between the endoscopic-harvest group and the open-harvest group at a median follow-up of 2.8 years.14 A small randomized controlled trial that included 54 patients demonstrated that the "no-touch technique" for SVG harvesting is superior to conventional harvesting and provides long-term patency rates that are comparable with the left internal thoracic artery.15 SVG preservation in buffered solutions preserves intimal integrity and can improve patency over grafts preserved in normal saline or blood-based solutions.16 The appropriate length of the SVG is of importance to avoid both overstretching and kinking17 and to preserve good target runoff.18 Measuring intraoperative graft flow potentially identifies technical problems with the anastomoses and outflow targets, thus identifying the need for revision to improve early graft patency.19 Some studies report sequential grafting providing inferior patency rates compared with single grafts,20 although as many studies report no difference between both strategies.21 Additionally, the risk for competitive (native coronary) flow causing reduction or even reversal of graft flow when grafting less then high-grade stenotic coronary arteries is less important in SVG than in arterial grafts and has to be taken in consideration when planning the revascularization.22 Furthermore, competitive flow presumably has more impact in sequential grafts including Y- or T-constructions. Last, off-pump CABG has been reported to be associated with inferior patency rates,23 although the current consensus is that in experienced hands, both off-pump and on-pump CABG attain excellent clinical outcomes in most patients.

Postoperative Therapies

Lifestyle and behavioral factors are associated with risk for SVG failure. It is established that smoking18 and hyperlipidaemia24 are associated with SVG failure. Diabetes and probably hypertension influence graft occlusion after CABG,25,26 and management of both decreases adverse clinical events.27,28 Therefore, addressing risk factors by adequate secondary prevention remains the cornerstone of strategies to improve graft patency.

(Video) Heart Minute | Graft Failure after CABG

Antithrombotic Therapies
SVG failure is up to five times more frequent in patients who are not treated with aspirin postoperatively,29 and early postoperative use is associated with a reduced risk of death and ischemic complications, albeit with a slight increase in perioperative bleeding.30,31 Therefore, guidelines recommend the preoperative or early postoperative use of aspirin.1,32,33 More potent platelet inhibition could potentially provide better patency after CABG. However, studies investigating additional antithrombotic therapies after CABG have not provided definite conclusions. Addition of dipyridamole does not appear to improve SVG patency34 and might lead to worse clinical outcomes after CABG35; therefore, it is not recommended.32,33

The addition of the P2Y12 inhibitor clopidogrel to aspirin did not improve SVG patency in certain studies,5 whereas in others it showed better SVG patency.36 This may be due to 30% of patients having an inadequate inhibitory response to clopidogrel. Nonetheless, addition of the stronger P2Y12 inhibitor ticagrelor to aspirin does not conclusively render better SVG patency,37,38 although ticagrelor has hardly any variability in response.

Oral anticoagulation provides no improvement in SVG patency rates compared with aspirin,39,40 but it causes more bleeding complications.40 Guidelines therefore advise against routinely administering vitamin K antagonists in patients undergoing CABG without other indications for vitamin K antagonists.33 There is currently only limited evidence concerning the effect of novel oral anticoagulants after CABG. The recent COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) CABG substudy (n = 1,448 patients) did not show an effect on graft patency of rivaroxaban plus aspirin compared with rivaroxaban monotherapy or aspirin monotherapy.41

Lipid-Lowering Therapies
Statin therapy reduces SVG occlusion rates as well as adverse events after CABG.42,43 Guidelines recommend statin therapy in all patients with diagnosed coronary artery disease,1 and in patients undergoing CABG, statin therapy is to be initiated preoperatively and continued for life.1 Addition of ezetimibe in patients with prior CABG might amplify the clinical benefits of statin therapy,44 as might treatment with PCSK9 inhibitors,45 although more definite conclusions regarding the effect on SVG patency are awaited (NCT03900026, NCT03542110).

(Video) WATCH Triple Bypass Open Heart Surgery

Other Therapies
Applying external support on the outer surface of the SVG by using an external stent targets factors such as high wall tension and disturbed flow patterns, which could lead to deterioration of the graft. This technique of external stenting is promising for preventing intimal hyperplasia and improving SVG patency.46 New techniques like immunomodulation47 and gene therapy6 are currently being investigated.

SVG failure is a complex, multifactorial process and is related to adverse outcomes after CABG. SVG occlusion rates are around 11% at 1 year after CABG. Technical factors during surgery and SVG construction are important in optimizing SVG patency. Secondary prevention aimed at preserving SVG patency should address risk factors for SVG failure and include antithrombotic therapy with aspirin and lipid-lowering therapies. Attempts to further improve SVG patency have resulted in the development of promising new targets, such as external stenting of the SVG.


  1. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011;58:e123-e210.
  2. Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol 2004;44:2149-56.
  3. Sabik JF 3rd, Blackstone EH, Gillinov AM, Banbury MK, Smedira NG, Lytle BW. Influence of patient characteristics and arterial grafts on freedom from coronary reoperation. J Thorac Cardiovasc Surg 2006;131:90-8.
  4. Boylan MJ, Lytle BW, Loop FD, et al. Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. J Thorac Cardiovasc Surg 1994;107:657-62.
  5. Kulik A, Le May MR, Voisine P, et al. Aspirin plus clopidogrel versus aspirin alone after coronary artery bypass grafting: the clopidogrel after surgery for coronary artery disease (CASCADE) Trial. Circulation 2010;122:2680-7.
  6. Alexander JH, Hafley G, Harrington RA, et al. Efficacy and safety of edifoligide, an E2F transcription factor decoy, for prevention of vein graft failure following coronary artery bypass graft surgery: PREVENT IV: a randomized controlled trial. JAMA 2005;294:2446-54.
  7. Cameron AA, Davis KB, Rogers WJ. Recurrence of angina after coronary artery bypass surgery: predictors and prognosis (CASS Registry). Coronary Artery Surgery Study. J Am Coll Cardiol 1995;26:895-9.
  8. Halabi AR, Alexander JH, Shaw LK, et al. Relation of early saphenous vein graft failure to outcomes following coronary artery bypass surgery. Am J Cardiol 2005;96:1254-9.
  9. Fitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper GD, Burton JR. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol 1996;28:616-26.
  10. Gaudino M, Antoniades C, Benedetto U, et al. Mechanisms, Consequences, and Prevention of Coronary Graft Failure. Circulation 2017;136:1749-64.
  11. Mitra AK, Gangahar DM, Agrawal DK. Cellular, molecular and immunological mechanisms in the pathophysiology of vein graft intimal hyperplasia. Immunol Cell Biol 2006;84:115-24.
  12. Boyle EM Jr, Lille ST, Allaire E, Clowes AW, Verrier ED. Endothelial cell injury in cardiovascular surgery: atherosclerosis. Ann Thorac Surg 1997;63:885-94.
  13. Hess CN, Lopes RD, Gibson CM, et al. Saphenous vein graft failure after coronary artery bypass surgery: insights from PREVENT IV. Circulation 2014;130:1445-51.
  14. Zenati MA, Bhatt DL, Bakaeen FG, et al. Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for Coronary-Artery Bypass. N Engl J Med 2019;380:132-41.
  15. Samano N, Geijer H, Liden M, Fremes S, Bodin L, Souza D. The no-touch saphenous vein for coronary artery bypass grafting maintains a patency, after 16 years, comparable to the left internal thoracic artery: A randomized trial. J Thorac Cardiovasc Surg 2015;150:880-8.
  16. Harskamp RE, Alexander JH, Schulte PJ, et al. Vein graft preservation solutions, patency, and outcomes after coronary artery bypass graft surgery: follow-up from the PREVENT IV randomized clinical trial. JAMA Surg 2014;149:798-805.
  17. Sabik JF 3rd. Understanding saphenous vein graft patency. Circulation 2011;124:273-5.
  18. Harskamp RE, Lopes RD, Baisden CE, de Winter RJ, Alexander JH. Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions. Ann Surg 2013;257:824-33.
  19. Thuijs DJFM, Bekker MWA, Taggart DP, et al. Improving coronary artery bypass grafting: a systematic review and meta-analysis on the impact of adopting transit-time flow measurement. Eur J Cardiothorac Surg 2019;56:654-33.
  20. Mehta RH, Ferguson TB, Lopes RD, et al. Saphenous vein grafts with multiple versus single distal targets in patients undergoing coronary artery bypass surgery: one-year graft failure and five-year outcomes from the Project of Ex-Vivo Vein Graft Engineering via Transfection (PREVENT) IV trial. Circulation 2011;124:280-8.
  21. Ouzounian M, Hassan A, Yip AM, et al. The impact of sequential grafting on clinical outcomes following coronary artery bypass grafting. Eur J Cardiothorac Surg 2010;38:579-84.
  22. Pagni S, Storey J, Ballen J, et al. ITA versus SVG: a comparison of instantaneous pressure and flow dynamics during competitive flow. Eur J Cardiothorac Surg 1997;11:1086-92.
  23. Sellke FW, DiMaio JM, Caplan LR, et al. Comparing on-pump and off-pump coronary artery bypass grafting: numerous studies but few conclusions: a scientific statement from the American Heart Association council on cardiovascular surgery and anesthesia in collaboration with the interdisciplinary working group on quality of care and outcomes research. Circulation 2005;111:2858-64.
  24. Daida H, Yokoi H, Miyano H, et al. Relation of saphenous vein graft obstruction to serum cholesterol levels. J Am Coll Cardiol 1995;25:193-7.
  25. Desai ND, Naylor CD, Kiss A, et al. Impact of patient and target-vessel characteristics on arterial and venous bypass graft patency: insight from a randomized trial. Circulation 2007;115:684-91.
  26. Une D, Kulik A, Voisine P, Le May M, Ruel M. Correlates of saphenous vein graft hyperplasia and occlusion 1 year after coronary artery bypass grafting: analysis from the CASCADE randomized trial. Circulation 2013;128:S213-S218.
  27. Zhang H, Yuan X, Zhang H, et al. Efficacy of Long-Term β-Blocker Therapy for Secondary Prevention of Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery. Circulation 2015;131:2194-201.
  28. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HAW. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008;359:1577-89.
  29. Zimmermann N, Gams E, Hohlfeld T. Aspirin in coronary artery bypass surgery: new aspects of and alternatives for an old antithrombotic agent. 2008;34:93-108.
  30. Mangano DT, Multicenter Study of Perioperative Ischemia Research Group. Aspirin and mortality from coronary bypass surgery. N Engl J Med 2002;347:1309-17.
  31. Hastings S, Myles P, McIlroy D. Aspirin and coronary artery surgery: a systematic review and meta-analysis. Br J Anaesth 2015;115:376-85.
  32. Ferraris VA, Saha SP, Oestreich JH, et al. 2012 update to the Society of Thoracic Surgeons guideline on use of antiplatelet drugs in patients having cardiac and noncardiac operations. Ann Thorac Surg 2012;94:1761-81.
  33. Stein PD, Schünemann HJ, Dalen JE, Gutterman D. Antithrombotic therapy in patients with saphenous vein and internal mammary artery bypass grafts: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126:600S-608S.
  34. Goldman S, Copeland J, Moritz T, et al. Saphenous vein graft patency 1 year after coronary artery bypass surgery and effects of antiplatelet therapy. Results of a Veterans Administration Cooperative Study. Circulation 1989;80:1190-7.
  35. van der Meer J, Brutel de la Rivière A, van Gilst WH, et al. Effects of low dose aspirin (50 mg/day), low dose aspirin plus dipyridamole, and oral anticoagulant agents after internal mammary artery bypass grafting: patency and clinical outcome at 1 year. CABADAS Research Group of the Interuniversity Cardiology Institute of The Netherlands. Prevention of Coronary Artery Bypass Graft Occlusion by Aspirin, Dipyridamole and Acenocoumarol/Phenprocoumon Study. J Am Coll Cardiol 1994;24:1181-8.
  36. Gao G, Zheng Z, Pi Y, Lu B, Lu J, Hu S. Aspirin plus clopidogrel therapy increases early venous graft patency after coronary artery bypass surgery a single-center, randomized, controlled trial. J Am Coll Cardiol 2010;56:1639-43.
  37. Zhao Q, Zhu Y, Xu Z, et al. Effect of Ticagrelor Plus Aspirin, Ticagrelor Alone, or Aspirin Alone on Saphenous Vein Graft Patency 1 Year After Coronary Artery Bypass Grafting: A Randomized Clinical Trial. JAMA 2018;319:1677-86.
  38. Willemsen LM, Janssen PWA, Peper J, et al. Effect of Adding Ticagrelor to Standard Aspirin on Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting (POPular CABG): A Randomized, Double-Blind, Placebo-Controlled Trial. Circulation 2020;142:1799-807.
  39. van der Meer J, Hillege HL, Kootstra GJ, et al. Prevention of one-year vein-graft occlusion after aortocoronary-bypass surgery: a comparison of low-dose aspirin, low-dose aspirin plus dipyridamole, and oral anticoagulants. The CABADAS Research Group of the Interuniversity Cardiology Institute of The Netherlands. Lancet 1993;342:257-64.
  40. Pfisterer M, Burkart F, Jockers G, et al. Trial of low-dose aspirin plus dipyridamole versus anticoagulants for prevention of aortocoronary vein graft occlusion. Lancet 1989;2:1-7.
  41. Lamy A, Eikelboom J, Sheth T, et al. Rivaroxaban, Aspirin, or Both to Prevent Early Coronary Bypass Graft Occlusion: The COMPASS-CABG Study. J Am Coll Cardiol 2019;73:121-30.
  42. Post Coronary Artery Bypass Graft Trial Investigators. The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts. N Engl J Med 1997;336:153-62.
  43. Liakopoulos OJ, Choi YH, Haldenwang PL, et al. Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30,000 patients. Eur Heart J 2008;29:1548-59.
  44. Eisen A, Cannon CP, Blazing MA, et al. The benefit of adding ezetimibe to statin therapy in patients with prior coronary artery bypass graft surgery and acute coronary syndrome in the IMPROVE-IT trial. Eur Heart J 2016;37:3576-84.
  45. Goodman SG, Aylward PE, Szarek M, et al. Effects of Alirocumab on Cardiovascular Events After Coronary Bypass Surgery. J Am Coll Cardiol 2019;74:1177-86.
  46. Taggart DP, Webb CM, Desouza A, et al. Long-term performance of an external stent for saphenous vein grafts: the VEST IV trial. J Cardiothorac Surg 2018;13:117.
  47. Smith PK, Shernan SK, Chen JC, et al. Effects of C5 complement inhibitor pexelizumab on outcome in high-risk coronary artery bypass grafting: combined results from the PRIMO-CABG I and II trials. J Thorac Cardiovasc Surg 2011;142:89-98.
(Video) Measures to Improve Utilization of Multiple Arterial Grafts for Isolated CABG

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Pericardial Disease, Prevention, Stable Ischemic Heart Disease, Aortic Surgery, Cardiac Surgery and SIHD, Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Interventions and ACS, Interventions and Imaging, Angiography, Echocardiography/Ultrasound, Nuclear Imaging, Hypertension, Chronic Angina

Keywords: Platelet Aggregation Inhibitors, Blood Pressure, Timolol, Cholesterol, LDL, Patient Discharge, PCSK9 protein, human, Cholesterol, HDL, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Proprotein Convertase 9, Proprotein Convertase 9, Coronary Vessels, Aspirin, Hydrochlorothiazide, Mammary Arteries, Cardiac Rehabilitation, Exercise Test, Exercise Test, Heart Rate, Angina, Stable, Acute Coronary Syndrome, Triglycerides, Hyperlipidemias, Constriction, Pathologic, Pericardial Effusion, Ophthalmic Solutions, Follow-Up Studies, Coronary Artery Bypass, Electrocardiography, Percutaneous Coronary Intervention, Hypotension, Hypertension, Echocardiography, Stents, Ischemia, Diuresis, Hospitals, Angiography

< Back to Listings


What conduit has the best rate for maintaining patency when used as a graft for CABG? ›

Internal thoracic artery

Currently, it is considered the standard for CABG and is recognized by cardiothoracic surgeons as the most effective and reliable conduit due to its excellent permeability, lower incidence of adverse events, and greater long-term survival for the patient.

What decreases saphenous vein graft failure? ›

The use of dual antiplatelet therapy (DAPT), either with clopidogrel or ticagrelor (Brilinta; AstraZeneca), appears to reduce the risk of failing saphenous vein grafts among patients who undergo CABG surgery, a new network meta-analysis suggests.

What is the patency rate of a CABG graft? ›

The most effective approach used during the CABG is the anastomosis of the left internal thoracic (mammary) artery to the left anterior descending artery [1-3]. The 10-year patency rate of the left internal thoracic artery graft is 90% [4,5].

Is dual antiplatelet therapy indicated after CABG? ›

The latest guidelines recommend the use of DAPT one year after CABG in patients with ACS (1, 9), although available evidence is limited to small RCTs and meta-analyses are substudies of larger RTCs. However, the choice between aspirin and which P2Y12 inhibitor to use remains unclear in CABG.

Which artery is the gold standard for CABG? ›

The internal mammary artery is the gold-standard bypass conduit and is associated with significant improvement in short and long-term outcomes and survival of patients.

Why is Lima used for CABG? ›

The Left internal mammary artery (LIMA) is considered the conduit of choice for the surgical treatment (CABG, coronary artery bypass grafting) of Coronary artery disease (CAD) due to its superior long term potency than the other conduits.

Why do saphenous vein grafts fail? ›

After grafting, the implanted vein remodels to become more arterial, as veins have thinner walls than arteries and can handle less blood pressure. However, the remodeling can go awry and the vein can become too thick, resulting in a recurrence of clogged blood flow.

What is the failure rate of saphenous vein graft? ›

Approximately 50% of saphenous vein grafts (SVGs) fail by 5 to 10 years post-coronary artery bypass grafting (CABG) and between 20–40% fail within the first year (1,2). While SVG failure can sometimes be silent, when symptomatic events occur, SVG percutaneous coronary intervention (PCI) is often performed.

How long do saphenous vein grafts last? ›

However, its durability and longevity are not ideal. One year after coronary surgery, 10% to 20% of saphenous vein grafts fail. From 1 to 5 years, an additional 5% to 10% fail, and from 6 to 10 years, an additional 20% to 25% fail.

Can CABG grafts be stented? ›

After surgery

Sometimes, a coronary artery bypass graft may need to be repeated or you may need a procedure to widen your arteries using a small balloon and a tube called a stent (coronary angioplasty).

How long do CABG grafts last? ›

How long do bypass grafts last? People tend to do very well after heart bypass and most get a good 15 years before needing another intervention, which at that point would almost always be having a stent inserted.

What is the most popular vein to harvest for CABG? ›

Both endoscopic and open vein harvesting call for removal of the greater saphenous vein in the leg for use in coronary artery bypass grafting, the most common type of open-heart surgery.

What is one of the most common antiplatelet therapies prescribed to patients with a post ischemic stroke? ›

Aspirin is the best-known antiplatelet medication. Clopidogrel, cilostazol, and dipyridamole are other antiplatelets sometimes prescribed.

When should I restart clopidogrel after CABG? ›

Restarting clopidogrel after CABG will depend on whether the stented vessel was revascularized, the type of stent and the time from stent implantation. Clopidogrel should be restarted when hemostasis is assured to prevent recurrent acute ischemic events.

How many hours after cabg surgery can anti platelet medications aspirin clopidogrel be resumed? ›

Postoperative Treatment

If aspirin therapy has been interrupted before surgery, it should be administered early after surgery, always within 48 hours after CABG, and preferably within 6 hours after surgery. Dose ranges between 150-325 mg/day; optimal benefit could be reach with 325 mg/day, at least the first year.

What is the best graft for CABG? ›

Saphenous vein was the conduit used in the first series of coronary artery bypass grafting (CABG), and, with the exception of surgical revascularization of the left anterior descending artery, it remains the most commonly used bypass conduit.

Is CABG considered heart failure? ›

Heart failure is the most common cause of death among coronary artery bypass graft (CABG) patients. In addition, most variation in observed mortality rates for CABG surgery is explained by fatal heart failure.

What is the most commonly used graft for CABG? ›

CABG involves the placement of one or more grafts between the aorta and coronary artery circulation. Arterial and venous grafts are used as bypass grafts and most patients receive some combination of the two. However, long-term graft patency is significantly better with the former.

What are the disadvantages of Lima graft? ›

However, the LIMA does have drawbacks. With a smaller capacitance, its rate of flow is less than the SVG and it cannot perfuse large myocardial territories quickly. It is susceptible to competing flow from a native coronary. Because it arises from the subclavian artery, it depends on subclavian patency.

What is five bypasses called? ›

When you have quintuple bypass surgery, this means you have five blocked arteries. During the surgery, these blockages are bypassed with healthy blood vessels taken from somewhere else in your body. A quintuple bypass indicates that all five of the major vessels to the heart are diseased.

Are there drawbacks in using the saphenous vein? ›

Premature vein graft failure along with blockage is the most significant drawback of saphenous vein grafts.

What is the most common cause of graft failure? ›

Acute rejection is the most common cause of graft failure based on the primary biopsy diagnosis.

What causes early CABG graft failure? ›

Early graft failure may be caused by acute thrombosis, secondary to either direct endothelial injury or endothelial activation, leading to a prothrombotic phenotype.

What happens if a CABG graft fails? ›

The main shortcoming of CABG is saphenous vein graft (SVG) failure, which is associated with adverse cardiac events, such as recurrent angina, need for repeated coronary revascularization, myocardial infarction, and death [7, 8].

How long does it take for a vein graft to heal? ›

Most people make a full recovery within 12 weeks of the operation. But if you experience complications during or after surgery, your recovery time is likely to be longer. You should have a follow-up appointment, typically about 6 to 8 weeks after your operation.

What causes vein graft failure? ›

Three processes are responsible for vein graft failure. Thrombosis, intimal hyperplasia and accelerated atherosclerosis contribute to graft failure in the acute, subacute and late postoperative periods, respectively.

What happens to the saphenous vein after CABG? ›

The saphenous vein that runs along the inner thigh is one of the most common blood vessels used in CABG. Within a year after surgery, the vein segments can become blocked - about 15% of the time, which can lead to the recurrence of chest pain.

How do you prevent graft occlusion? ›

Vein graft occlusion occurs frequently and is related to adverse outcomes after coronary artery bypass grafting (CABG). Technical factors during CABG are determinative for early graft patency. To prevent vein graft occlusion, lifestyle management, antithrombotic therapies, and lipid-lowering therapies are key.

Are radial artery bypass grafts better than saphenous vein grafts? ›

The use of radial-artery grafts for coronary-artery bypass grafting (CABG) may result in better postoperative outcomes than the use of saphenous-vein grafts.

What is the Widowmaker? ›

The widow-maker is a massive heart attack that occurs when the left anterior descending artery (LAD) is totally or almost completely blocked. The critical blockage in the artery stops, usually a blood clot, stops all the blood flow to the left side of the heart, causing the heart to stop beating normally.

Can the widow maker artery be stented? ›

A long-term Korean study found stents as safe as open heart surgery in treating blockages of a coronary artery known as the widowmaker, showing that stented patients did not run a significantly higher risk of suffering a heart attack or stroke.

Can bypass vein be stented? ›

Stenting in saphenous coronary bypass grafts can be performed safely with excellent immediate angiographic and clinical results. Early occlusion, late restenosis, and bleeding complications associated with the aggressive anticoagulant treatment remain significant limitations.

What happens 10 years after CABG? ›

The study shows that ten-year-survivors have an increased mortality of between 60 and 80 per cent when compared with the general population. This may be due to the fact that the disease is progressive and that the atherosclerosis or hardening of the arteries increases, or that the implanted material begins to fail.

Can you live 20 years after CABG? ›

Ten years after initial CABG surgery, 79%, 87%, 94%, and 99% of patients aged <50, 50 to 60, 60 to 70, and >70 years, respectively were free from repeat CABG. At 20 years, 47%, 58%, 74%, and 92% of patients aged <50, 50 to 60, 60 to 70, and >70 years were free from repeat CABG.

Can you live 30 years after CABG? ›

A total of 82% of patients in the CABG group and 37% of those in the PCI group had multivessel coronary artery disease. The cumulative survival rates at 10, 20, 30 and 40 years were 77%, 39%, 14% and 4% after CABG, respectively, and at 10, 20, 30 and 35 years after PCI were 78%, 47%, 21% and 12%, respectively.

Is CABG obsolete? ›

In the U.S., CABG surgery is by far the most common heart surgery, and, indeed, one of the most common surgeries of any kind. But in Europe and Japan, CABG is dying out so fast that heart surgeons in those places view it as archaic, seriously threatening the profession of cardiac surgery (see the quotes above).

What foods to avoid after coronary bypass surgery? ›

To keep blood vessels clear after bypass surgery, avoid foods high in fat and cholesterol, such as whole milk, cheese, cream, ice cream, butter, high-fat meats, egg yolks, baked desserts, and any foods that are fried.

Why is vein taken from leg for bypass surgery? ›

The doctor will take a vein or artery from another part of your body and use it to make a detour (or graft) around the blocked area in your artery. Your doctor may use a vein, called the saphenous vein, from your leg.

What is the best antiplatelet therapy? ›

Clopidogrel (75 mg daily) is the preferred antiplatelet. If intolerant of clopidogrel, aspirin in combination with modified-release dipyridamole (200 mg twice a day).

What is the only antiplatelet agent that has been proven to be effective for the acute treatment of ischemic stroke? ›

For acute treatment of nonembolic TIA or ischemic stroke, 2 trials have convincingly demonstrated reductions in recurrent ischemic strokes with the combination of aspirin and clopidogrel (versus aspirin monotherapy), lasting 21 or 90 days.

Which medication is the most common and effective antiplatelet aggregation agent? ›

Aspirin, the most commonly used antiplatelet drug changes the balance between prostacyclin (which inhibits platelet aggregation) and thromboxane (that promotes aggregation).

How long should you take Plavix after CABG? ›

In case of CABG and left ventricular thrombus, the latest ESC guidelines define 6 months of anticoagulation for the management of left ventricular thrombus, guided by repeated imaging (4). Guidelines and especially clinical practice are not uniform and specific regarding DAPT in patients scheduled for CABG.

When Should clopidogrel be stopped? ›

While current guidelines recommend cessation of clopidogrel 5 to 7 days before an operative procedure, our data demonstrate that timing of clopidogrel cessation within 7 days of an operative procedure does not affect the prevalence of postoperative bleeding requiring transfusion or mortality.

How long take statins after CABG? ›

Initiation of statin therapy between 1 and 6 months after CABG discharge was also associated with reductions in major adverse cardiovascular events and mortality; however, outcome rates between early (≤1 month after CABG) and delayed (1 to 6 months after CABG) statin initiation were not significantly different.

How long to continue dual antiplatelet therapy after CABG? ›

In patients with ACS (NSTE-ACS or STEMI) being treated with DAPT who undergo coronary artery bypass grafting (CABG), P2Y12 inhibitor therapy should be resumed after CABG to complete 12 months of DAPT therapy after ACS (Class I).

Do you need dual antiplatelet after CABG? ›

Typically, patients are given aspirin following CABG. However, some evidence suggests that dual antiplatelet therapy – aspirin along with a prescription strength antiplatelet agent such as ticagrelor – can more effectively prevent this clotting within the grafted vein.

Should aspirin be stopped before CABG? ›

The American College of Cardiology and American Heart Association guideline18 recommends that aspirin should be stopped 7 to 10 days before CABG.

What conduits are used in CABG? ›

The standard conduits used for CABG are the greater saphenous vein (GSV) and the internal thoracic artery (ITA).

Which graft is best for CABG? ›

CABG involves the placement of one or more grafts between the aorta and coronary artery circulation. Arterial and venous grafts are used as bypass grafts and most patients receive some combination of the two. However, long-term graft patency is significantly better with the former.

Which is the preferred bypass graft used in CABG? ›

Saphenous vein was the conduit used in the first series of coronary artery bypass grafting (CABG), and, with the exception of surgical revascularization of the left anterior descending artery, it remains the most commonly used bypass conduit.

Which blood vessel is most commonly used as a graft for heart bypass surgery? ›

Internal thoracic artery

As the most commonly used bypass grafts, the internal thoracic (mammary) artery (ITA) grafts show the best long-term results.

What is octopus in CABG? ›

The Octopus Tissue Stabilizer consists of two suction paddles that are placed in parallel on either side of the coronary artery and it utilizes suction pressure of 300–400 mm Hg to effectively immobilize the target site.

When should a stent be used instead of a CABG? ›

Stenting is a quick way to open a blocked artery. In an emergency, it is usually preferred over CABG. An acute ST-segment elevation myocardial infarction (STEMI) is the most dangerous kind of heart attack. If you have this kind of heart attack, an angioplasty can save your life.

Why do CABG grafts fail? ›

After grafting, the implanted vein remodels to become more arterial, as veins have thinner walls than arteries and can handle less blood pressure. However, the remodeling can go awry and the vein can become too thick, resulting in a recurrence of clogged blood flow.

Which is better Lima or saphenous vein graft? ›

The LIMA is the gold standard conduit in CABG and has consistently shown to be associated with improved long-term survival, graft patency, and a lower rate of re-intervention as compared with the saphenous vein graft (SVG) conduits [5].

When is PCI preferred over CABG? ›

PCI can be pursued but tends to be inferior to CABG for a distal left main (bifurcation) lesion, especially in combination with 2- or 3-vessel disease and a SYNTAX score of <32.

What is the failure rate of CABG grafts? ›

Approximately 50% of saphenous vein grafts (SVGs) fail by 5 to 10 years post-coronary artery bypass grafting (CABG) and between 20–40% fail within the first year (1,2).

Why is PCI preferred over CABG? ›

concluded that PCI significantly reduces the risk of stroke compared to CABG. particularly in female patients, but the risk of revascularization is increased with PCI, especially in women and in those with diabetes (26).

How fast can arteries clog after bypass surgery? ›

Within a year after surgery, the vein segments can become blocked - about 15% of the time, which can lead to the recurrence of chest pain. “Improving the rate at which vein grafts remain open has always been a core issue of CABG surgery,” said cardiac surgeon Shengshou Hu, M.D., Ph.

What is the best exercise after heart surgery? ›

Pace yourself when climbing stairs. Exercising in cold and windy or hot and humid weather puts stress on your heart. If temperatures outside are below 40 degrees or above 75 degrees, then exercise indoors. Riding a stationary bike or walking on a treadmill is an acceptable alternative to walking.


1. ACC 22: FAME 3 Suggests CABG Outperforms FFR-Guided PCI in Patients with Multivessel Disease
2. Heart Minute | Graft Failure after CABG
(American College of Cardiology Video Archive 2)
3. Preventing Vein Graft Disease Following CABG: The Importance of Intraoperative Vein Graft Treatment
4. ACC.11 | STICH-Surgical Treatment for Ischemic Heart Failure
(American College of Cardiology Video Archive 2)
5. Heart Minute | Clopidogrel After MI & CABG
(American College of Cardiology Video Archive 2)
6. Multiple Arterial Grafts in CABG: Decreased Post-Operative Renal Failure and Stroke
(Johns Hopkins Medicine)
Top Articles
Latest Posts
Article information

Author: Foster Heidenreich CPA

Last Updated: 01/02/2023

Views: 5457

Rating: 4.6 / 5 (76 voted)

Reviews: 83% of readers found this page helpful

Author information

Name: Foster Heidenreich CPA

Birthday: 1995-01-14

Address: 55021 Usha Garden, North Larisa, DE 19209

Phone: +6812240846623

Job: Corporate Healthcare Strategist

Hobby: Singing, Listening to music, Rafting, LARPing, Gardening, Quilting, Rappelling

Introduction: My name is Foster Heidenreich CPA, I am a delightful, quaint, glorious, quaint, faithful, enchanting, fine person who loves writing and wants to share my knowledge and understanding with you.